Provider Demographics
NPI:1760852305
Name:COUTU CHAM, DEBORAH A (RN, CDOE)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:COUTU CHAM
Suffix:
Gender:F
Credentials:RN, CDOE
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:KHOUNSAVATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 CORLISS ST STE B
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2602
Mailing Address - Country:US
Mailing Address - Phone:401-793-8400
Mailing Address - Fax:401-793-8402
Practice Address - Street 1:180 CORLISS ST STE B
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2602
Practice Address - Country:US
Practice Address - Phone:401-793-8400
Practice Address - Fax:401-793-8402
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN46400163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator